Kathleen Doheny wrote the WebMD article, What You Should Know About ‘Superbug’ CRE:

Feb. 20, 2015 — The ”superbug” infection at the heart of an outbreak at Ronald Reagan UCLA Medical Center in Los Angeles is sometimes called “the nightmare bacteria” because it’s so resistant to antibiotics.
Two deaths at the California medical center are linked to the bacteria, known as CRE, or carbapenem-resistant Enterobacteriaceae. Five other patients are infected and nearly 200 may have been exposed, the center says. Exposure stemmed from two contaminated instruments used during procedures done over the past few months at the facility…
What is CRE and how does it spread?
CRE is in a family of bacteria that are normally found in the gut and have become resistant to antibiotics. They are resistant to most of the available antibiotics, says Stephen Calderwood, MD. He’s the president of the Infectious Diseases Society of America and chief of the infectious disease division at Massachusetts General Hospital, Boston.
The devices linked with the UCLA outbreak, known as duodenoscopes, are used in more than 500,000 procedures a year in the U.S., according to the CDC.
The scope is inserted into the mouth and through the throat, stomach, and the top of the small intestine. It helps doctors diagnose and treat diseases of the liver, bile ducts and pancreas. The FDA warned that the scopes might still carry a risk of infection even after proper cleaning procedures.
The problems can start when the bacteria leave the intestine and live in other areas, such as the urinary tract, lungs, skin, and on medical equipment, Calderwood says. “They mainly cause infections when they get to a certain number and the ability of the body to fight off infection breaks down.”
Who is most at risk?
“Most healthy people don’t get these infections,” says Robert Glatter, MD. He’s an emergency medicine doctor at Lenox Hill Hospital, New York. “It’s the people living in long-term care facilities, nursing homes, or who have long hospital stays.”
Those who get infected often have other diseases, are on antibiotics, and have had a procedure involving a medical device, Calderwood says…. http://www.webmd.com/a-to-z-guides/news/20150220/superbug-cre-infections#1

Science Daily reported in Antibiotic-resistant microbes date back to 450 million years ago, well before the age of dinosaurs:

Leading hospital “superbugs,” known as the enterococci, arose from an ancestor that dates back 450 million years — about the time when animals were first crawling onto land (and well before the age of dinosaurs), according to a new study led by researchers from Massachusetts Eye and Ear, the Harvard-wide Program on Antibiotic Resistance and the Broad Institute of MIT and Harvard. Published online today in Cell, the study authors shed light on the evolutionary history of these pathogens, which evolved nearly indestructible properties and have become leading causes of modern antibiotic-resistant infections in hospitals.
Antibiotic resistance is now a leading public health concern worldwide. Some microbes, often referred to as “superbugs,” are resistant to virtually all antibiotics. This is of special concern in hospitals, where about 5 percent of hospitalized patients will fight infections that arise during their stay. As researchers around the world are urgently seeking solutions for this problem, insight into the origin and evolution of antibiotic resistance will help inform their search.
“By analyzing the genomes and behaviors of today’s enterococci, we were able to rewind the clock back to their earliest existence and piece together a picture of how these organisms were shaped into what they are today” said co-corresponding author Ashlee M. Earl, Ph.D., group leader for the Bacterial Genomics Group at the Broad Institute of MIT and Harvard. “Understanding how the environment in which microbes live leads to new properties could help us to predict how microbes will adapt to the use of antibiotics, antimicrobial hand soaps, disinfectants and other products intended to control their spread.”
The picture the researchers pieced together begins with the dawn of life. Bacteria arose nearly 4 billion years ago, and the planet has teemed with them ever since, including the sea. Animals first arose in the sea during the time known as the Cambrian Explosion, 542 million years ago. As animals emerged in a sea of bacteria, bacteria learned to live in and on them. Some bacteria protect and serve the animals, as the healthy microbes in our intestines do today; others live in the environment, and still others cause disease. As animals crawled onto land about 100 million years later, they took their microbes with them.
The authors of the Cell study found that all species of enterococci, including those that have never been found in hospitals, were naturally resistant to dryness, starvation, disinfectants and many antibiotics. Because enterococci normally live in the intestines of most (if not all) land animals, it seemed likely that they were also in the intestines of land animals that are now extinct, including dinosaurs and the first millipede-like organisms to crawl onto land. Comparison of the genomes of these bacteria provided evidence that this was indeed the case. In fact, the research team found that new species of enterococci appeared whenever new types of animals appeared. This includes when new types of animals arose right after they first crawled onto land, and when new types of animals arose right after mass extinctions, especially the greatest mass extinction, the End Permian Extinction (251 million years ago)…. https://www.sciencedaily.com/releases/2017/05/170511142012.htm

Citation:

Antibiotic-resistant microbes date back to 450 million years ago, well before the age of dinosaurs
Survival of mass extinctions helps to explain near indestructible properties of hospital superbugs
Date: May 11, 2017
Source: Massachusetts Eye and Ear Infirmary
Summary:
Leading hospital ‘superbugs,’ known as the enterococci, arose from an ancestor that dates back 450 million years — about the time when animals were first crawling onto land (and well before the age of dinosaurs), according to a new study.
Journal Reference:
1. François Lebreton, Abigail L. Manson, Jose T. Saavedra, Timothy J. Straub, Ashlee M. Earl, Michael S. Gilmore. Tracing the Enterococci from Paleozoic Origins to the Hospital. Cell, 2017; DOI: 10.1016/j.cell.2017.04.027

Here is the press release from Massachusetts Eye and Ear:
The Prehistory of Antibiotic Resistance
Hospital “superbugs” evolved from an ancient ancestor

An artist’s rendering of what life may have looked 335 million years ago, well before the age of By Suzanne Day May 12, 2017
Leading hospital “superbugs” known as the enterococci arose from an ancestor that dates back 450 million years—about the time when animals were first crawling onto land (and well before the age of dinosaurs), according to a new study led by researchers from Harvard Medical School, Massachusetts Eye and Ear, the Harvard-wide Program on Antibiotic Resistance and the Broad Institute of MIT and Harvard. Published in Cell, the study authors shed light on the evolutionary history of these pathogens, which evolved nearly indestructible properties and have become leading causes of modern antibiotic-resistant infections in hospitals.
Antibiotic resistance is now a major public health concern worldwide. Some microbes, often referred to as “superbugs,” are resistant to virtually all antibiotics. This is of special concern in hospitals, where about 5 percent of hospitalized patients will fight infections that arise during their stay. As researchers around the world are urgently seeking solutions to this problem, insight into the origin and evolution of antibiotic resistance will help inform their search.
“By analyzing the genomes and behaviors of today’s enterococci, we were able to rewind the clock back to their earliest existence and piece together a picture of how these organisms were shaped into what they are today” said co-corresponding author Ashlee Earl, group leader for the Bacterial Genomics Group at the Broad. “Understanding how the environment in which microbes live leads to new properties could help us to predict how microbes will adapt to the use of antibiotics, antimicrobial hand soaps, disinfectants and other products intended to control their spread.”
The picture the researchers pieced together begins with the dawn of life. Bacteria arose nearly 4 billion years ago, and the planet has teemed with them ever since. Animals first arose in the sea during the period known as the Cambrian Explosion, around 542 million years ago. As animals emerged in a sea of bacteria, the bacteria learned to live in and on them. Some bacteria protect and serve the animals, as the healthy microbes in our intestines do today; others live in the environment and still others cause disease. As animals crawled onto land about 100 million years later, they brought their microbes with them.
“We now know what genes were gained by enterococci hundreds of millions of years ago, when they became resistant to drying out.” —Michael Gilmore
The authors of the Cell study found that all species of enterococci, including those that have never been found in hospitals, are naturally resistant to dryness, starvation, disinfectants and many antibiotics. Because enterococci normally live in the intestines of most (if not all) land animals, it seemed likely that they were also in the intestines of land animals that are now extinct, including dinosaurs and the first millipede-like organisms to crawl onto land. Comparisons of the genomes of these bacteria provided evidence that this is indeed the case. In fact, the research team found that new species of enterococci appeared whenever new types of animals appeared.
Sea animals excrete intestinal microbes into the ocean, which usually contains about 5,000 mostly harmless bacteria per drop of water. These organisms sink to the seafloor into microbe-rich sediments and are consumed by worms, shellfish and other sea scavengers. Those are then eaten by fish, and the microbes continue to circulate throughout the food chain. However, on land, intestinal microbes are excreted in feces, where most dry out and die over time.
Not the enterococci, however. These microbes are unusually hardy and can withstand drying out and starvation, which serves them well on land and in hospitals where disinfectants make survival difficult for a microbe.
“We now know what genes were gained by enterococci hundreds of millions of years ago, when they became resistant to drying out, and to disinfectants and antibiotics that attack their cell walls,” said principal investigator and co-corresponding author Michael Gilmore, the HMS Sir William Osler Professor of Ophthalmology at Mass. Eye and Ear and director of the Harvard Infectious Disease Institute.
“These are now targets for our research to design new types of antibiotics and disinfectants that specifically eliminate enterococci, to remove them as threats to hospitalized patients,” added Francois Lebreton, HMS instructor in ophthalmology, first author of the study and project leader for the Gilmore team.
This research study was supported by Department of Health and Human Services/National Institutes of Health/National Institute of Allergy and Infectious Diseases (grants AI072360, AI083214, HHSN272200900018C and U19AI110818).
Adapted from a Mass. Eye and Ear news release. http://www.masseyeandear.org/news/press-releases/2017/05/antibiotic-resistant-microbes-date-backhttps://hms.harvard.edu/news/prehistory-antibiotic-resistance

Appropriate use of antibiotics is crucial in limiting the danger of superbugs.

National Institutes of Health in the News reported in the 2014 article, Stop the Spread of Superbugs: Help Fight Drug-Resistant Bacteria:

Unfortunately, many antibiotics prescribed to people and to animals are unnecessary. And the overuse and misuse of antibiotics helps to create drug-resistant bacteria.
Here’s how that might happen. When used properly, antibiotics can help destroy disease-causing bacteria. But if you take an antibiotic when you have a viral infection like the flu, the drug won’t affect the viruses making you sick. Instead, it’ll destroy a wide variety of bacteria in your body, including some of the “good” bacteria that help you digest food, fight infection, and stay healthy. Bacteria that are tough enough to survive the drug will have a chance to grow and quickly multiply. These drug-resistant strains may even spread to other people.
Over time, if more and more people take antibiotics when not necessary, drug-resistant bacteria can continue to thrive and spread. They may even share their drug-resistant traits with other bacteria. Drugs may become less effective or not work at all against certain disease-causing bacteria.
“Bacterial infections that were treatable for decades are no longer responding to antibiotics, even the newer ones,” says Dr. Dennis Dixon, an NIH expert in bacterial and fungal diseases. Scientists have been trying to keep ahead of newly emerging drug-resistant bacteria by developing new drugs, but it’s a tough task.
“We need to make the best use of the drugs we have, as there aren’t many in the antibiotic development pipeline,” says Dr. Jane Knisely, who oversees studies of drug-resistant bacteria at NIH. “It’s important to understand the best way to use these drugs to increase their effectiveness and decrease the chances of resistance to emerge.”
You can help slow the spread of drug-resistant bacteria by taking antibiotics properly and only when needed. Don’t insist on an antibiotic if your health care provider advises otherwise. For example, many parents expect doctors to prescribe antibiotics for a child’s ear infection. But experts recommend delaying for a time in certain situations, as many ear infections get better without antibiotics.
NIH researchers have been looking at whether antibiotics are effective for treating certain conditions in the first place. One recent study showed that antibiotics may be less effective than previously thought for treating a common type of sinus infection. This kind of research can help prevent the misuse and overuse of antibiotics.
“Treating infections with antibiotics is something we want to preserve for generations to come, so we shouldn’t misuse them,” says Dr. Julie Segre, a senior investigator at NIH.
In the past, some of the most dangerous superbugs have been confined to health care settings. That’s because people who are sick or in a weakened state are more susceptible to picking up infections. But superbug infections aren’t limited to hospitals. Some strains are out in the community and anyone, even healthy people, can become infected.
One common superbug increasingly seen outside hospitals is methicillin-resistant Staphylococcus aureus (MRSA). These bacteria don’t respond to methicillin and related antibiotics. MRSA can cause skin infections and, in more serious cases, pneumonia or bloodstream infections.
A MRSA skin infection can appear as one or more pimples or boils that are swollen, painful, or hot to the touch. The infection can spread through even a tiny cut or scrape that comes into contact with these bacteria. Many people recover from MRSA infections, but some cases can be life-threatening. The CDC estimates that more than 80,000 aggressive MRSA infections and 11,000 related deaths occur each year in the United States.
When antibiotics are needed, doctors usually prescribe a mild one before trying something more aggressive like vancomycin. Such newer antibiotics can be more toxic and more expensive than older ones. Eventually, bacteria will develop resistance to even the new drugs. In recent years, some superbugs, such as vancomycin-resistant Enterococci bacteria, remain unaffected by even this antibiotic of last resort.
“We rely on antibiotics to deliver modern health care,” Segre says. But with the rise of drug-resistant bacteria, “we’re running out of new antibiotics to treat bacterial infections,” and some of the more potent ones aren’t working as well…. https://newsinhealth.nih.gov/issue/feb2014/feature1

Like opioids, antibiotics must be carefully prescribed by a competent medical professional who is careful not to overprescribe.